| Code | Description | Claims | Beneficiaries | Total Paid |
| 80050 |
General health panel |
298,380 |
283,576 |
$4.97M |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
376,261 |
353,273 |
$4.16M |
| 80081 |
|
90,712 |
87,026 |
$3.75M |
| 80061 |
Lipid panel |
564,277 |
528,652 |
$2.80M |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
107,580 |
98,497 |
$2.71M |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
188,938 |
179,483 |
$2.59M |
| 80053 |
Comprehensive metabolic panel |
602,367 |
556,352 |
$2.36M |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
613,210 |
565,045 |
$2.13M |
| 84443 |
Thyroid stimulating hormone (TSH) |
341,439 |
319,348 |
$2.02M |
| 83036 |
Hemoglobin; glycosylated (A1C) |
471,429 |
442,695 |
$1.56M |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
364,062 |
337,752 |
$1.48M |
| G0480 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed |
44,052 |
39,480 |
$1.35M |
| 82607 |
|
211,823 |
199,590 |
$1.28M |
| 80074 |
|
69,835 |
65,990 |
$1.21M |
| 86235 |
|
22,354 |
20,682 |
$1.18M |
| 86003 |
|
18,036 |
15,950 |
$936K |
| 84702 |
|
112,927 |
91,248 |
$831K |
| 86803 |
|
102,283 |
96,694 |
$789K |
| 84403 |
|
64,128 |
60,218 |
$782K |
| 86780 |
|
95,292 |
88,630 |
$752K |
| 84439 |
|
199,223 |
187,576 |
$719K |
| 82746 |
|
102,622 |
96,481 |
$581K |
| 82728 |
|
109,056 |
102,124 |
$567K |
| 82670 |
|
41,790 |
39,563 |
$562K |
| 84481 |
|
78,883 |
74,384 |
$556K |
| 83970 |
|
52,269 |
47,424 |
$550K |
| 86696 |
|
55,716 |
50,172 |
$533K |
| 87077 |
|
124,006 |
105,385 |
$460K |
| 84144 |
|
42,514 |
37,545 |
$446K |
| 87186 |
|
110,284 |
94,795 |
$439K |
| 83001 |
|
45,253 |
43,128 |
$434K |
| 85027 |
|
137,841 |
128,147 |
$434K |
| 82105 |
|
44,445 |
41,991 |
$387K |
| 84153 |
|
43,764 |
40,992 |
$340K |
| 83013 |
|
10,814 |
10,309 |
$339K |
| 82652 |
|
22,318 |
21,053 |
$337K |
| 86480 |
|
12,793 |
12,094 |
$336K |
| 87340 |
|
59,887 |
56,411 |
$323K |
| 84146 |
|
30,248 |
28,672 |
$318K |
| 83540 |
|
123,357 |
115,040 |
$311K |
| 83002 |
|
33,572 |
32,050 |
$309K |
| 82950 |
|
91,136 |
88,208 |
$293K |
| 86695 |
|
44,432 |
39,782 |
$290K |
| 84270 |
|
28,635 |
26,928 |
$286K |
| 86038 |
|
51,152 |
45,386 |
$277K |
| 83735 |
|
104,411 |
95,776 |
$272K |
| 82677 |
|
16,653 |
15,905 |
$271K |
| 86769 |
|
10,379 |
9,044 |
$261K |
| 87070 |
|
57,146 |
54,383 |
$260K |
| 86376 |
|
36,167 |
34,073 |
$259K |
| 83880 |
|
19,738 |
17,968 |
$259K |
| 83550 |
|
72,049 |
67,489 |
$245K |
| 84480 |
|
38,491 |
36,005 |
$225K |
| 82951 |
|
27,589 |
26,385 |
$224K |
| 80055 |
|
9,610 |
9,137 |
$219K |
| 82570 |
|
107,285 |
98,307 |
$214K |
| 86850 |
|
34,772 |
32,770 |
$213K |
| 82627 |
|
17,948 |
17,012 |
$198K |
| 83655 |
|
25,716 |
25,186 |
$189K |
| 86336 |
|
16,522 |
15,772 |
$185K |
| 83516 |
|
39,304 |
22,236 |
$180K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
55,746 |
50,188 |
$172K |
| 86787 |
|
23,353 |
19,527 |
$171K |
| 86800 |
|
21,632 |
20,576 |
$168K |
| 86762 |
|
18,912 |
17,234 |
$167K |
| 86592 |
|
69,673 |
66,208 |
$164K |
| 83525 |
|
29,763 |
28,289 |
$160K |
| 86694 |
|
20,511 |
19,545 |
$158K |
| 86665 |
|
15,983 |
7,955 |
$158K |
| 86140 |
|
69,016 |
64,266 |
$152K |
| 86225 |
|
23,678 |
21,691 |
$149K |
| 82043 |
|
74,023 |
68,329 |
$143K |
| 82785 |
|
14,819 |
13,916 |
$141K |
| 84466 |
|
23,491 |
22,209 |
$140K |
| 84550 |
|
73,664 |
67,934 |
$139K |
| 87081 |
|
43,685 |
41,626 |
$139K |
| 83690 |
|
36,366 |
34,200 |
$127K |
| 81001 |
|
85,699 |
78,076 |
$126K |
| 86147 |
|
10,246 |
3,881 |
$121K |
| 86706 |
|
27,728 |
26,097 |
$121K |
| 83020 |
|
14,923 |
13,982 |
$116K |
| 83520 |
|
19,188 |
14,243 |
$114K |
| 82150 |
|
32,093 |
29,988 |
$104K |
| 86160 |
|
22,816 |
10,546 |
$98K |
| 85660 |
|
25,684 |
24,541 |
$97K |
| 82977 |
|
22,333 |
21,140 |
$96K |
| 85652 |
|
74,477 |
69,745 |
$95K |
| 84436 |
|
35,376 |
33,043 |
$91K |
| 80069 |
|
46,560 |
40,901 |
$91K |
| 84402 |
|
6,959 |
6,601 |
$90K |
| 86708 |
|
16,270 |
15,117 |
$87K |
| 81003 |
|
76,896 |
65,091 |
$86K |
| 86704 |
|
16,635 |
15,692 |
$85K |
| 82248 |
|
33,528 |
31,094 |
$85K |
| 86200 |
|
14,530 |
13,439 |
$83K |
| 82784 |
|
19,253 |
12,716 |
$83K |
| 84156 |
|
60,565 |
54,485 |
$79K |
| 86431 |
|
28,156 |
26,490 |
$72K |
| 86901 |
|
26,492 |
24,927 |
$70K |
| 83498 |
|
4,391 |
4,228 |
$70K |
| 87205 |
|
29,405 |
27,231 |
$68K |
| 80076 |
|
15,363 |
14,167 |
$65K |
| 86146 |
|
6,155 |
2,099 |
$60K |
| 82533 |
|
7,643 |
6,909 |
$60K |
| 83090 |
|
10,143 |
9,389 |
$59K |
| 82947 |
|
23,240 |
21,867 |
$58K |
| 86317 |
|
11,570 |
2,297 |
$58K |
| 85610 |
|
32,460 |
27,689 |
$56K |
| 86870 |
|
3,043 |
2,824 |
$56K |
| 82550 |
|
21,412 |
19,757 |
$56K |
| 86757 |
|
8,222 |
3,514 |
$56K |
| 87075 |
|
11,945 |
11,165 |
$55K |
| 82671 |
|
3,354 |
3,202 |
$53K |
| 86900 |
|
26,907 |
25,317 |
$52K |
| 86664 |
|
6,129 |
5,871 |
$51K |
| 86705 |
|
10,444 |
9,810 |
$51K |
| 84681 |
|
6,485 |
6,017 |
$51K |
| 83615 |
|
13,989 |
12,590 |
$47K |
| 85730 |
|
18,814 |
16,791 |
$47K |
| 87522 |
Neg quan hep c or qual rna |
2,280 |
2,092 |
$46K |
| 86663 |
|
6,282 |
6,013 |
$45K |
| 83010 |
|
7,843 |
7,344 |
$44K |
| 82239 |
|
3,777 |
3,293 |
$43K |
| 82952 |
|
16,390 |
15,917 |
$41K |
| 82565 |
|
12,265 |
10,571 |
$40K |
| 84703 |
|
9,066 |
8,597 |
$40K |
| 86618 |
|
2,798 |
2,606 |
$39K |
| 85018 |
|
29,332 |
27,614 |
$39K |
| 80164 |
|
6,862 |
6,379 |
$39K |
| 87046 |
|
10,084 |
4,866 |
$38K |
| 86430 |
|
18,463 |
8,917 |
$38K |
| 85014 |
|
28,187 |
26,501 |
$37K |
| 86334 |
|
4,972 |
4,568 |
$36K |
| 86008 |
|
14,348 |
3,650 |
$35K |
| 86361 |
|
3,323 |
3,102 |
$34K |
| 84450 |
|
13,293 |
12,245 |
$33K |
| 82024 |
|
1,931 |
1,801 |
$33K |
| 86258 |
|
8,155 |
3,983 |
$32K |
| 86747 |
|
4,672 |
2,445 |
$32K |
| 83883 |
|
6,054 |
4,317 |
$31K |
| 82731 |
|
730 |
642 |
$30K |
| 86677 |
|
5,096 |
4,072 |
$30K |
| 85598 |
|
3,404 |
3,191 |
$29K |
| 86645 |
|
3,218 |
3,064 |
$29K |
| 84425 |
|
3,002 |
2,829 |
$28K |
| 86617 |
|
1,944 |
1,828 |
$28K |
| 84445 |
|
1,112 |
1,020 |
$27K |
| 84460 |
|
12,639 |
11,822 |
$27K |
| 86039 |
|
5,485 |
5,172 |
$27K |
| 87209 |
|
2,916 |
2,719 |
$27K |
| 82140 |
|
4,532 |
4,104 |
$26K |
| 86141 |
|
4,268 |
3,979 |
$26K |
| 86644 |
|
3,338 |
3,103 |
$26K |
| 86666 |
|
2,147 |
1,994 |
$25K |
| 80177 |
|
4,566 |
4,272 |
$25K |
| G0481 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed |
845 |
782 |
$24K |
| 84154 |
|
4,264 |
3,954 |
$24K |
| 84100 |
|
16,134 |
14,400 |
$24K |
| 86304 |
|
3,085 |
2,880 |
$24K |
| 87045 |
|
5,182 |
4,949 |
$23K |
| 82157 |
|
1,588 |
1,525 |
$23K |
| 86364 |
|
5,689 |
4,853 |
$22K |
| 85379 |
|
4,460 |
4,132 |
$22K |
| 87252 |
|
1,593 |
1,479 |
$22K |
| 83876 |
|
1,743 |
1,608 |
$21K |
| 85246 |
|
1,398 |
1,288 |
$21K |
| 87255 |
|
1,099 |
1,068 |
$21K |
| 82378 |
|
2,962 |
2,733 |
$20K |
| 82626 |
|
1,452 |
1,405 |
$20K |
| 86709 |
|
3,445 |
3,272 |
$20K |
| 84482 |
|
2,319 |
2,181 |
$20K |
| 81025 |
|
4,192 |
3,940 |
$20K |
| 86255 |
|
4,246 |
3,808 |
$19K |
| 81596 |
|
1,041 |
978 |
$19K |
| 83014 |
|
4,507 |
4,317 |
$19K |
| 82465 |
|
8,821 |
8,603 |
$19K |
| 85240 |
|
1,623 |
1,536 |
$19K |
| 82247 |
|
6,519 |
5,355 |
$18K |
| 82088 |
|
920 |
829 |
$18K |
| 84165 |
|
4,519 |
4,124 |
$17K |
| 83921 |
|
1,794 |
1,707 |
$17K |
| 85306 |
|
1,997 |
1,796 |
$17K |
| 84163 |
|
2,481 |
2,389 |
$17K |
| 85045 |
|
9,435 |
8,798 |
$16K |
| 83527 |
|
2,867 |
2,769 |
$16K |
| 80185 |
|
3,231 |
2,912 |
$16K |
| 85613 |
|
3,727 |
3,218 |
$16K |
| 84378 |
|
3,716 |
3,463 |
$16K |
| 87449 |
|
3,680 |
1,761 |
$16K |
| 80051 |
|
3,773 |
3,233 |
$15K |
| 85303 |
|
1,922 |
1,824 |
$15K |
| 84207 |
|
1,187 |
1,123 |
$15K |
| 84305 |
|
1,575 |
1,487 |
$14K |
| 85007 |
|
5,497 |
5,313 |
$14K |
| 83993 |
|
1,763 |
1,644 |
$14K |
| 85245 |
|
877 |
852 |
$14K |
| 87339 |
|
1,843 |
1,530 |
$14K |
| 86707 |
|
2,248 |
2,179 |
$13K |
| 84484 |
|
2,593 |
2,317 |
$13K |
| 82103 |
|
2,306 |
2,162 |
$13K |
| 86341 |
|
2,341 |
1,090 |
$13K |
| 86812 |
|
1,493 |
1,382 |
$13K |
| 84166 |
|
2,371 |
1,562 |
$12K |
| 87177 |
|
2,910 |
2,712 |
$12K |
| 87253 |
|
1,129 |
1,062 |
$12K |
| 83704 |
|
842 |
766 |
$12K |
| 87634 |
|
331 |
328 |
$11K |
| 85300 |
|
1,753 |
1,663 |
$11K |
| 86148 |
|
2,331 |
728 |
$11K |
| 84478 |
|
3,732 |
3,458 |
$11K |
| 86765 |
|
1,882 |
1,728 |
$11K |
| 86593 |
|
4,051 |
3,755 |
$11K |
| 84520 |
|
6,444 |
5,822 |
$11K |
| 82575 |
|
2,026 |
1,917 |
$11K |
| 83521 |
|
3,240 |
1,430 |
$10K |
| 86735 |
|
1,699 |
1,542 |
$10K |
| 82274 |
|
2,491 |
2,259 |
$10K |
| 84134 |
|
1,953 |
1,680 |
$10K |
| 80197 |
|
2,984 |
2,400 |
$10K |
| 84630 |
|
1,585 |
1,460 |
$10K |
| 80178 |
|
3,279 |
2,986 |
$10K |
| 84238 |
|
379 |
365 |
$9K |
| 86360 |
|
319 |
294 |
$9K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,249 |
1,187 |
$9K |
| 82310 |
|
3,878 |
3,559 |
$9K |
| 80175 |
|
1,669 |
1,583 |
$9K |
| 86886 |
|
2,458 |
2,277 |
$9K |
| 86001 |
|
662 |
624 |
$9K |
| 86381 |
|
1,269 |
1,220 |
$9K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
964 |
468 |
$9K |
| 84244 |
|
758 |
699 |
$8K |
| 82390 |
|
1,849 |
1,734 |
$8K |
| 85301 |
|
1,331 |
1,276 |
$8K |
| 82553 |
|
1,349 |
1,253 |
$8K |
| 82330 |
|
1,573 |
1,455 |
$7K |
| 86060 |
|
1,898 |
1,804 |
$7K |
| 81015 |
|
5,487 |
5,175 |
$7K |
| 87430 |
|
864 |
819 |
$7K |
| 83021 |
|
573 |
474 |
$7K |
| 86335 |
|
718 |
642 |
$7K |
| 80156 |
|
1,166 |
1,074 |
$7K |
| 84075 |
|
3,040 |
2,740 |
$7K |
| 86308 |
|
2,192 |
2,098 |
$7K |
| 82040 |
|
2,213 |
2,032 |
$7K |
| 84479 |
|
2,736 |
2,603 |
$6K |
| 84132 |
|
2,940 |
2,642 |
$6K |
| 83721 |
|
2,265 |
2,100 |
$6K |
| 82525 |
|
936 |
886 |
$6K |
| 87338 |
|
929 |
896 |
$6K |
| 86359 |
|
258 |
242 |
$6K |
| 87350 |
|
1,006 |
964 |
$6K |
| 82166 |
|
501 |
477 |
$6K |
| G0103 |
Prostate cancer screening; prostate specific antigen test (psa) |
12,535 |
11,719 |
$6K |
| 86777 |
|
800 |
752 |
$5K |
| 85384 |
|
1,097 |
1,030 |
$5K |
| 84432 |
|
665 |
621 |
$5K |
| 87341 |
|
1,000 |
941 |
$5K |
| 87102 |
|
1,285 |
1,212 |
$5K |
| 82610 |
|
1,301 |
1,215 |
$5K |
| 86702 |
|
817 |
762 |
$5K |
| 87207 |
|
1,925 |
1,122 |
$5K |
| 85305 |
|
717 |
672 |
$5K |
| 82747 |
|
542 |
514 |
$4K |
| 86300 |
|
503 |
423 |
$4K |
| 84155 |
|
3,168 |
2,934 |
$4K |
| 87015 |
|
1,561 |
765 |
$4K |
| 86753 |
|
972 |
479 |
$4K |
| 85397 |
|
212 |
202 |
$4K |
| 86015 |
|
1,223 |
1,158 |
$4K |
| 82668 |
|
373 |
348 |
$3K |
| 82955 |
|
827 |
781 |
$3K |
| 85302 |
|
543 |
507 |
$3K |
| 86701 |
|
829 |
774 |
$3K |
| 86671 |
|
561 |
294 |
$3K |
| 82530 |
|
328 |
288 |
$3K |
| 82085 |
|
765 |
732 |
$3K |
| 83519 |
|
515 |
415 |
$3K |
| 82107 |
|
185 |
180 |
$3K |
| 86778 |
|
455 |
429 |
$3K |
| 82787 |
|
948 |
277 |
$3K |
| 86256 |
|
358 |
317 |
$3K |
| 87328 |
|
406 |
383 |
$3K |
| 87807 |
|
304 |
294 |
$3K |
| 84080 |
|
520 |
471 |
$3K |
| 89055 |
|
1,382 |
1,319 |
$2K |
| 86316 |
|
364 |
308 |
$2K |
| 82653 |
|
317 |
301 |
$2K |
| 82365 |
|
324 |
305 |
$2K |
| 86021 |
|
402 |
332 |
$2K |
| 82172 |
|
494 |
363 |
$2K |
| 85049 |
|
884 |
814 |
$2K |
| 82397 |
|
358 |
348 |
$2K |
| 86162 |
|
196 |
168 |
$2K |
| 84140 |
|
208 |
202 |
$2K |
| 82272 |
|
1,198 |
810 |
$2K |
| 86668 |
|
238 |
105 |
$2K |
| 82164 |
|
219 |
209 |
$2K |
| 86611 |
|
544 |
159 |
$2K |
| 87076 |
|
355 |
305 |
$2K |
| 84300 |
|
1,227 |
1,109 |
$2K |
| 82104 |
|
243 |
232 |
$2K |
| 80349 |
|
72 |
71 |
$2K |
| 87632 |
|
21 |
20 |
$1K |
| 83018 |
|
84 |
83 |
$1K |
| 87101 |
|
298 |
279 |
$1K |
| 80183 |
|
196 |
182 |
$1K |
| 82679 |
|
81 |
77 |
$1K |
| 86231 |
|
275 |
266 |
$952.42 |
| 80323 |
|
539 |
526 |
$944.46 |
| 81005 |
|
813 |
771 |
$913.80 |
| 86301 |
|
109 |
106 |
$903.14 |
| 80184 |
|
257 |
242 |
$900.56 |
| 87040 |
|
182 |
128 |
$875.98 |
| 85732 |
|
245 |
136 |
$851.29 |
| 83088 |
|
42 |
39 |
$787.29 |
| 80171 |
|
215 |
193 |
$726.48 |
| 83695 |
|
332 |
306 |
$701.03 |
| 87210 |
|
240 |
221 |
$674.81 |
| 87109 |
|
74 |
70 |
$651.60 |
| 83935 |
|
346 |
304 |
$595.65 |
| 87329 |
|
75 |
73 |
$543.49 |
| 87420 |
|
93 |
91 |
$541.78 |
| 82681 |
|
36 |
33 |
$461.40 |
| 80165 |
|
82 |
81 |
$445.16 |
| 82672 |
|
41 |
40 |
$431.31 |
| 83630 |
|
28 |
27 |
$429.50 |
| 80355 |
|
80 |
55 |
$428.63 |
| 80201 |
|
146 |
141 |
$422.74 |
| 86337 |
|
43 |
40 |
$379.97 |
| 86000 |
|
170 |
154 |
$368.88 |
| 80162 |
|
112 |
103 |
$367.35 |
| 86036 |
|
143 |
128 |
$366.07 |
| 83930 |
|
236 |
206 |
$345.39 |
| 86738 |
|
30 |
15 |
$330.68 |
| 86343 |
|
38 |
36 |
$327.67 |
| 83718 |
|
72 |
70 |
$280.38 |
| 85060 |
|
27 |
26 |
$278.64 |
| 86774 |
|
29 |
26 |
$271.36 |
| 87385 |
|
13 |
12 |
$268.98 |
| 82642 |
|
26 |
26 |
$267.34 |
| 80299 |
|
109 |
103 |
$260.38 |
| 86632 |
|
32 |
12 |
$227.45 |
| 36415 |
Collection of venous blood by venipuncture |
146 |
83 |
$221.65 |
| 83874 |
|
48 |
45 |
$211.71 |
| 84590 |
|
26 |
26 |
$203.99 |
| 85048 |
|
119 |
72 |
$180.68 |
| 84446 |
|
25 |
25 |
$177.79 |
| 86880 |
|
60 |
36 |
$174.04 |
| 83835 |
|
28 |
24 |
$161.79 |
| 82232 |
|
42 |
38 |
$153.61 |
| 82657 |
|
15 |
15 |
$142.85 |
| 84255 |
|
12 |
12 |
$137.19 |
| 87140 |
|
49 |
27 |
$131.27 |
| 86215 |
|
14 |
14 |
$123.93 |
| 86703 |
|
16 |
13 |
$118.94 |
| 82985 |
|
29 |
28 |
$118.25 |
| 85520 |
|
13 |
12 |
$99.07 |
| 86790 |
|
18 |
17 |
$91.44 |
| 83631 |
|
13 |
13 |
$86.46 |
| 83992 |
|
132 |
114 |
$84.78 |
| 82077 |
|
44 |
39 |
$75.20 |
| 83003 |
|
12 |
12 |
$73.47 |
| 82340 |
|
25 |
25 |
$70.91 |
| 80047 |
|
27 |
26 |
$64.42 |
| 82705 |
|
33 |
32 |
$49.45 |
| 84376 |
|
16 |
16 |
$46.61 |
| 89050 |
|
13 |
13 |
$20.96 |
| 82270 |
|
12 |
12 |
$5.34 |
| 3044F |
|
1,763 |
1,572 |
$0.00 |
| 3052F |
|
66 |
52 |
$0.00 |
| 80320 |
|
170 |
133 |
$0.00 |
| 3051F |
|
174 |
146 |
$0.00 |
| 3046F |
|
275 |
228 |
$0.00 |